A two-month-old warmblood foal was presented with complaints of acute respiratory distress and lethargy. Bothclinical examination and blood tests revealed icterus, dyspnea and kidney failure. The foal was euthanized andnecropsy and histological examination showed extensive kidney damage, liver damage and alveolar hemorrhage. Thediagnosis of leptospirosis was confirmed by immunofluorescense. Unlike in human cases of leptospirosis, respiratorysymptoms caused by alveolar hemorrhage in horses are not often associated with leptospirosis. This case shows thatthe frequency of respiratory complications caused by alveolar hemorrhage after leptospira infection might beunderestimated. It is important to consider leptospirosis in the differential diagnosis of dyspnea in the foal.